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Gao Z, Zhang H, Zhang F, Wang L, Pan J, Shi X, Li J, Shen L, Yang H. Micropercutaneous nephrostomy for intervention in acute upper urinary tract calculi obstruction with hydronephrosis and infection. Sci Rep 2024; 14:25787. [PMID: 39468201 PMCID: PMC11519635 DOI: 10.1038/s41598-024-77078-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Accepted: 10/18/2024] [Indexed: 10/30/2024] Open
Abstract
To compare the efficacy and advantages of mini percutaneous nephrostomy (MPCN), micropercutaneous nephrostomy (MicroPCN), and retrograde ureteric stenting (RUS) in the treatment of acute upper urinary tract calculi (UUTC) obstruction with hydronephrosis and infection, and verify the safety and indications of clinical application of micropercutaneous nephrostomy. Clinical-epidemiological data of patients with acute upper urinary tract calculi obstruction and infection treated in Ningbo No.2 hospital were retrospectively collected from May 2019 to May 2023. 64 patients (20 patients in MPCN group, 13 patients in MicroPCN group, and 31 patients in RUS group) were eligible for analysis based on inclusion and exclusion criteria. P value < 0.05 was considered statistically significant. There were no significant differences in peri-intervention temperature, multiple infection indicators and complications among the three groups. The nutritional status and peri-intervention coagulation function of patients in MicroPCN and RUS groups were poor, the CRP and proportion of using carbapenem advanced antibiotics were higher. The length of hospital stay and the length of hospital stay after the intervention in MPCN and MicroPCN groups were longer, the length and width of calculi were larger, and the degree of hydronephrosis was heavier. Patients in the MicroPCN group had the worst general condition, the lowest hemoglobin before intervention, the longest withdrawal time of vasoactive drugs. MPCN, MicroPCN, and RUS are safe and effective in relieving acute upper urinary tract calculi obstruction complicated with infection. MicroPCN has more advantages for patients with critical illness or complex obstruction urinary lithiasis.
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Affiliation(s)
- Zhebin Gao
- Department of Urology, Chongqing Western Hospital, Chongqing, China
| | - Huayang Zhang
- Department of Urology, Chongqing Western Hospital, Chongqing, China
| | - Fei Zhang
- Department of Urology, NingBo No.2 Hospital, ZheJiang, 315000, China
| | - Li Wang
- Department of Urology, NingBo No.2 Hospital, ZheJiang, 315000, China
| | - Jiaren Pan
- Department of Urology, NingBo No.2 Hospital, ZheJiang, 315000, China
| | - Xiao Shi
- Department of Urology, NingBo No.2 Hospital, ZheJiang, 315000, China
| | - Jing Li
- Department of Urology, NingBo No.2 Hospital, ZheJiang, 315000, China
| | - Linkun Shen
- Department of Urology, NingBo No.2 Hospital, ZheJiang, 315000, China.
| | - Houmeng Yang
- Department of Urology, NingBo No.2 Hospital, ZheJiang, 315000, China.
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Pérez-Aizpurua X, Cabello Benavente R, Bueno Serrano G, Alcázar Peral JM, Gómez-Jordana Mañas B, Tufet i Jaumot J, Ruiz de Castroviejo Blanco J, Osorio Ospina F, Gonzalez-Enguita C. Obstructive uropathy: Overview of the pathogenesis, etiology and management of a prevalent cause of acute kidney injury. World J Nephrol 2024; 13:93322. [PMID: 38983763 PMCID: PMC11229834 DOI: 10.5527/wjn.v13.i2.93322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/24/2024] [Accepted: 06/18/2024] [Indexed: 06/25/2024] Open
Abstract
Obstructive uropathy is defined as the structural or functional interruption of urinary outflow at any level in the urinary tract. It is regarded as one of the most prevalent causes of acute kidney injury (AKI), accounting for 5%-10% of cases. Acute severe obstruction of the urinary tract is a potentially threatening situation for the kidneys and therefore requires prompt identification and management to relieve obstruction. The aim of the present article is to review and synthesize available evidence on obstructive uropathy, providing a clinical guideline for clinicians. A literature review on obstructive uropathy in the context of AKI was performed, focusing on the least clarified aspects regarding diagnosis and management. Recent literature searching was conducted in English and top-level evidence articles including systematic reviews, metanalyses and large series were prioritized. Acute obstruction of the urinary tract is a diagnostic and therapeutical challenge that may lead to important clinical complications together with direct structural and hemodynamic damage to the kidney. Early recognition of the leading cause and its exact location is essential to ensure prompt urinary drainage together with the most suitable drainage technique selection. A multidisciplinary approach, including urologists, nephrologists, and other medical specialties, is best suited to correctly manage concomitant hemodynamic changes, fluid and electrolyte imbalances, and other related issues. Obstructive uropathy is one of the leading causes of AKI. Recognition of patients suitable for early diversion and feasibility or adequate selection of the indicated technique is sometimes challenging. A thorough understanding of the physiopathology behind the development of urinary obstruction is vital for correct diagnosis and management.
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Affiliation(s)
- Xabier Pérez-Aizpurua
- Department of Urology, Hospital Universitario Fundación Jiménez Díaz, Madrid 28015, Madrid, Spain
| | - Ramiro Cabello Benavente
- Department of Urology, Hospital Universitario Fundación Jiménez Díaz, Madrid 28015, Madrid, Spain
| | - Gonzalo Bueno Serrano
- Department of Urology, Hospital Universitario Fundación Jiménez Díaz, Madrid 28015, Madrid, Spain
| | - José María Alcázar Peral
- Department of Urology, Hospital Universitario Fundación Jiménez Díaz, Madrid 28015, Madrid, Spain
| | | | - Jaime Tufet i Jaumot
- Department of Urology, Hospital Universitario Fundación Jiménez Díaz, Madrid 28015, Madrid, Spain
| | | | - Felipe Osorio Ospina
- Department of Urology, Hospital Universitario Fundación Jiménez Díaz, Madrid 28015, Madrid, Spain
| | - Carmen Gonzalez-Enguita
- Department of Urology, Hospital Universitario Fundación Jiménez Díaz, Madrid 28015, Madrid, Spain
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Moon YJ, Jun DY, Jeong JY, Cho S, Lee JY, Jung HD. Percutaneous Nephrostomy versus Ureteral Stent for Severe Urinary Tract Infection with Obstructive Urolithiasis: A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:861. [PMID: 38929478 PMCID: PMC11206041 DOI: 10.3390/medicina60060861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/09/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: The European Association of Urology guidelines on urolithiasis highlight the limited evidence supporting the superiority of percutaneous nephrostomy (PCN) over retrograde ureteral stent placement for the primary treatment of infected hydronephrosis secondary to urolithiasis. We, therefore, conducted a systematic review and meta-analysis comparing the effects of PCN and retrograde ureteral stent in patients with severe urinary tract infections secondary to obstructive urolithiasis. Materials and Methods: Meta-analyses were performed to compare four outcomes: time for the temperature to return to normal; time for the white blood cell (WBC) count to return to normal; hospital length of stay; and procedure success rate. After a full-text review, eight studies were identified as relevant and included in our systematic review and meta-analysis. Results: No significant difference was detected between PCN and retrograde ureteral stenting for the time for the temperature to return to normal (p = 0.13; mean difference [MD] = -0.74; 95% confidence interval [CI] = -1.69, 0.21; I2 = 96%) or the time for the WBC count to return to normal (p = 0.24; MD = 0.46; 95% CI = -0.30, 1.21; I2 = 85%). There was also no significant difference between methods for hospital length of stay (p = 0.78; MD = 0.45; 95% CI = -2.78, 3.68; I2 = 96%) or procedure success rate (p = 0.76; odds ratio = 0.86; 95% CI = 0.34, 2.20; I2 = 47%). Conclusions: The clinical outcomes related to efficacy did not differ between PCN and retrograde ureteral stenting for severe urinary tract infection with obstructive urolithiasis. Thus, the choice between procedures depends mainly on the urologist's or patient's preferences.
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Affiliation(s)
- Young Joon Moon
- Department of Medicine, Graduate School, Yonsei University, Seoul 03722, Republic of Korea;
| | - Dae Young Jun
- Department of Urology, Severance Hospital, Urological Science Institute, College of Medicine, Yonsei University, Seoul 03722, Republic of Korea; (D.Y.J.); (J.Y.L.)
| | - Jae Yong Jeong
- Department of Urology, National Health Insurance Service Ilsan Hospital, Goyang 10444, Republic of Korea;
| | - Seok Cho
- Department of Urology, Inje University Ilsan Paik Hospital, College of Medicine, Inje University, Goyang 10380, Republic of Korea;
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, College of Medicine, Yonsei University, Seoul 03722, Republic of Korea; (D.Y.J.); (J.Y.L.)
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul 03722, Republic of Korea
| | - Hae Do Jung
- Department of Urology, Inje University Ilsan Paik Hospital, College of Medicine, Inje University, Goyang 10380, Republic of Korea;
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Schrag TA, Diarra D, Veser J. Prevention, diagnosis, and treatment of urolithiasis in geriatric patients - differences, similarities and caveats in comparison to the general population. Curr Opin Urol 2024; 34:154-165. [PMID: 38445376 DOI: 10.1097/mou.0000000000001173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
PURPOSE OF REVIEW Purpose of the review is to address management and prevention of urolithiasis in elderly patients examining the dynamic interplay between general measures, dietary adjustments, lifestyle modifications, and targeted pharmacological and/ or surgical interventions. The goal is to provide understanding of the evolving strategies required for effective urolithiasis prevention in the geriatric population. RECENT FINDINGS Age-specific diagnostic considerations are necessary because urolithiasis in the elderly population is characterized by bigger stones, greater peri-operative risks, and heightened symptom severity. When comorbidities are present, conservative treatments - especially analgesia - provide difficulties. Surgical procedures prove to be safe and effective, with complication rates and practical application comparable to younger cohorts. Prevention approaches that include lifestyle changes and the investigation of novel pharmaceutical options such as sodium-dependent glucose co-transporter 2 (SGLT-2)-inhibitors are promising in the management of urolithiasis in the elderly population. SUMMARY Our review offers a thorough investigation of urolithiasis in the elderly population, elucidating distinct clinical manifestations, complex diagnostic issues, and treatment implications. The safety and effectiveness of ureteroscopy in older patients, as well as the possible prophylactic function of SGLT-2-I, offer crucial insights for clinicians. Subsequent studies are necessary to enhance age-specific therapies, addressing the distinct obstacles presented by urolithiasis in the elderly population within this rapidly growing demographic.
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Kamal W, Azhar RA, Hamri SB, Alathal AH, Alamri A, Alzahrani T, Abeery H, Noureldin YA, Alomar M, Al Own A, Alnazari MM, Alharthi M, Awad MA, Halawani A, Althubiany HH, Alruwaily A, Violette P. The Saudi urological association guidelines on urolithiasis. Urol Ann 2024; 16:1-27. [PMID: 38415236 PMCID: PMC10896325 DOI: 10.4103/ua.ua_120_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 12/24/2023] [Accepted: 12/28/2023] [Indexed: 02/29/2024] Open
Abstract
Aims The Saudi Urolithiasis Guidelines are a set of recommendations for diagnosing, evaluating, and treating urolithiasis in the Saudi population. These guidelines are based on the latest evidence and expert consensus to improve patient outcomes and optimize care delivery. They cover the various aspects of urolithiasis, including risk factors, diagnosis, medical and surgical treatments, and prevention strategies. By following these guidelines, health-care professionals can improve care quality for individuals with urolithiasis in Saudi Arabia. Panel The Saudi Urolithiasis Guidelines Panel consists of urologists specialized in endourology with expertise in urolithiasis and consultation with a guideline methodologist. All panelists involved in this document have submitted statements disclosing any potential conflicts of interest. Methods The Saudi Guidelines on Urolithiasis were developed by relying primarily on established international guidelines to adopt or adapt the most appropriate guidance for the Saudi context. When necessary, the panel modified the phrasing of recommendations from different sources to ensure consistency within the document. To address areas less well covered in existing guidelines, the panel conducted a directed literature search for high quality evidence published in English, including meta analyses, randomized controlled trials, and prospective nonrandomized comparative studies. The panel also searched for locally relevant studies containing information unique to the Saudi Arabian population. The recommendations are formulated with a direction and strength of recommendation based on GRADE terminology and interpretation while relying on existing summaries of evidence from the existing guidelines.
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Affiliation(s)
- Wissam Kamal
- Department of Urology, King Fahad General Hospital, Jeddah, Saudi Arabia
| | - Raed A Azhar
- Department of Urology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Abdulaziz H Alathal
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Division of Urology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdulaziz Alamri
- Surgery Department, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Tarek Alzahrani
- Dr. Sulaiman Al Habib Hospital (Swaidi), Riyadh, Saudi Arabia
| | | | - Yasser A Noureldin
- Division of Urology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Department of Urology, Faculty of Medicine, Benha University, Egypt
- Department of Clinical Sciences, Northern Ontario School of Medicine, ON, Canada
| | - Mohammad Alomar
- Department of Urology, King Fahad Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Mansour M Alnazari
- Department of Urology, College of Medicine, Taibah university, Madinah, Saudi Arabia
| | - Majid Alharthi
- Department of Urology, King Fahad General Hospital, Jeddah, Saudi Arabia
- Seoul National University Hospital, Seoul, South Korea
| | - Mohannad A Awad
- Department of Surgery, King Abdulaziz University, Rabigh, Saudi Arabia
- Department of Urology, University of Texas Southwestern Medical Southwestern Medical Centre, Dallas, TX, USA
| | - Abdulghafour Halawani
- Department of Urology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hatem Hamed Althubiany
- Department of Urology, Imam Abdulrahman Bin Faisal University, Dammam King Fahd Hospital of the University, Dammam, Saudi Arabia
| | | | - Phillipe Violette
- Woodstock General Hospital, London Ontario, Canada
- McMaster University, London Ontario, Canada
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Quaresma V, Magalhães F, Marconi L, Lima J, Lopes M, Ferreira AM, Nunes P, Figueiredo A. National consensus survey on management approaches for upper urinary tract obstruction: A comparative analysis of retrograde ureteric stent and percutaneous nephrostomy. Arch Ital Urol Androl 2023; 95:12118. [PMID: 38193221 DOI: 10.4081/aiua.2023.12118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 12/02/2023] [Indexed: 01/10/2024] Open
Abstract
To the Editor, Upper urinary tract obstruction (UUTO) is a common scenario in clinical practice, and it is caused by a variety of diseases. Lithiasis, tumours and strictures are some of the principal aetiologies. Multiple factors may influence both the need for decompression of the obstructed collecting system and the urgency of procedure...
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Affiliation(s)
- Vasco Quaresma
- Urology Department, Centro Hospitalar e Universitário de Coimbra; Faculty of Medicine of the University of Coimbra.
| | | | - Lorenzo Marconi
- Urology Department, Centro Hospitalar e Universitário de Coimbra; Faculty of Medicine of the University of Coimbra.
| | - João Lima
- Urology Department, Centro Hospitalar e Universitário de Coimbra; Faculty of Medicine of the University of Coimbra.
| | - Manuel Lopes
- Urology Department, Centro Hospitalar e Universitário de Coimbra.
| | | | - Pedro Nunes
- Urology Department, Centro Hospitalar e Universitário de Coimbra; Faculty of Medicine of the University of Coimbra.
| | - Arnaldo Figueiredo
- Urology Department, Centro Hospitalar e Universitário de Coimbra; Faculty of Medicine of the University of Coimbra.
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Liao S, Xu X, Yuan Y, Tang K, Wei G, Lu Z, Xiong L. A comparative study of flexible ureteroscopic lithotripsy for upper urinary tract stones in patients with prior urosepsis following emergency drainage via retrograde ureteral stent or percutaneous nephrostomy. BMC Urol 2023; 23:196. [PMID: 38017464 PMCID: PMC10685477 DOI: 10.1186/s12894-023-01369-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/14/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Patients with urosepsis associated with upper urinary tract stones require further stone management after emergency drainage. OBJECTIVE To evaluate the safety and efficacy of elective flexible ureteroscopic lithotripsy (F-URSL) for upper urinary tract stones in patients with prior urosepsis who have undergone emergency drainage using retrograde ureteral stent(RUS) or percutaneous nephrostomy (PCN). METHOD Between January 2017 and December 2021, clinical data were collected for 102 patients who underwent elective F-URSL following emergency drainage for urosepsis caused by upper ureteral or renal stones. The patients were categorized into two groups based on the drainage method used: the RUS group and the PCN group. The collected data included patient demographics, stone parameters, infection recovery after emergency drainage, and clinical outcomes post F-URSL. Subsequently, the data underwent statistical analysis. RESULTS A total of 102 patients were included in the statistical analysis, with 58 (56.86%) in the RUS group and 44 (43.14%) in the PCN group. Among the patients, 84 (82.35%) were female and 18 (17.65%) were male, with an average age of 59.36 years. Positive urine cultures were observed in 71 (69.61%) patients. Successful drainage was achieved in all patients in both groups, and there were no significant differences in the time required for normalization of white blood cell count (WBC) and body temperature following drainage. Additionally, all patients underwent F-URSL successfully, and no statistically significant differences were observed between the two groups in terms of operative time, stone-free rates, postoperative fever, and postoperative hospital stay. CONCLUSION Both RUS and PCN have been established as effective approaches for managing urosepsis caused by upper urinary tract stones. Furthermore, the impact of these two drainage methods on the subsequent management of stones through elective F-URSL has shown consistent outcomes.
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Affiliation(s)
- Sucai Liao
- Department of Urology, The University of Hong Kong-Shenzhen Hospital, 1 Haiyuan First Road, Futian District, Shenzhen, Guangdong, 518053, China
| | - Xiang Xu
- Department of Urology, The University of Hong Kong-Shenzhen Hospital, 1 Haiyuan First Road, Futian District, Shenzhen, Guangdong, 518053, China
| | - Yuan Yuan
- Department of Urology, The University of Hong Kong-Shenzhen Hospital, 1 Haiyuan First Road, Futian District, Shenzhen, Guangdong, 518053, China
| | - Keiyui Tang
- Department of General Surgery, University Hospitals Plymouth NHS Trust, Derriford Hospital, Plymouth, UK
| | - Genggeng Wei
- Department of Urology, The University of Hong Kong-Shenzhen Hospital, 1 Haiyuan First Road, Futian District, Shenzhen, Guangdong, 518053, China
| | - Zhengquan Lu
- Department of Urology, The University of Hong Kong-Shenzhen Hospital, 1 Haiyuan First Road, Futian District, Shenzhen, Guangdong, 518053, China
| | - Lin Xiong
- Department of Urology, The University of Hong Kong-Shenzhen Hospital, 1 Haiyuan First Road, Futian District, Shenzhen, Guangdong, 518053, China.
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Meria P, Raynal G, Denis E, Plassais C, Cornet P, Gil-Jardiné C, Almeras C. 2022 Recommendations of the AFU Lithiasis Committee: Management of symptomatic urinary stones. Prog Urol 2023; 33:791-811. [PMID: 37918980 DOI: 10.1016/j.purol.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
The acute situation, caused by an obstructive stone, is defined by a renal colic that may be uncomplicated, complicated, or at risk in specific conditions. Its management may be medical or require interventional treatment by extracorporeal shockwave lithotripsy, endoscopic removal, or ureteroscopy. METHODOLOGY: These recommendations were developed using two methods, the Clinical Practice Recommendations (CPR) and the ADAPTE method, in function of whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) [EAU Guidelines on urolithiasis. 2022] and whether they could be adapted to the French context.
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Affiliation(s)
- P Meria
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France
| | - G Raynal
- Clinique Métivet, department of urology, Saint-Maur-des-Fossés, France
| | - E Denis
- Centre hospitalier Saint-Joseph Saint-Luc, Lyon, France
| | - C Plassais
- Department of Urology, Hôpitaux Universitaires Pitié-Salpêtrière, Paris, France
| | - P Cornet
- Department of General Medicine, Sorbonne University, SFMG, Paris, France
| | - C Gil-Jardiné
- Pôle Urgences adultes - SAMU, Hôpital Pellegrin, CHU de Bordeaux, SFR-SIGU, Bordeaux, France; Inserm U1219, Bordeaux Population Health Research Centre, IETO Team, Bordeaux University, ISPED, Bordeaux, France
| | - C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
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Hsu CK, Young WL, Wu SY. Retrograde ureteral catheterization under local anesthesia for emergency drainage in patients with infection and hydronephrosis secondary to ureteral calculi: Experience from a tertiary care hospital. Tzu Chi Med J 2023; 35:317-321. [PMID: 38035064 PMCID: PMC10683527 DOI: 10.4103/tcmj.tcmj_11_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/07/2023] [Accepted: 04/06/2023] [Indexed: 12/02/2023] Open
Abstract
Objectives The aim is to evaluate the safety and efficacy of retrograde ureteral catheterization under local anesthesia in patients with urinary tract infections complicated by hydronephrosis caused by ureteral stone obstruction. Materials and Methods From October 2020 to September 2021, a retrospective analysis of patients' medical records was performed. Records of past history, physical examination, laboratory tests, and imaging investigations were reviewed. Retrograde ureteric stent (RUS) was performed under local anesthesia using cystoscopes and guided by portable fluoroscopy. Real-time fluoroscopy was used to verify the double-J stent position and confirm a smooth process. The postoperative recovery and length of admission were also recorded. Results A total of 14 patients with ureteral stone obstruction with infective hydronephrosis received 15 total emergency RUS procedures (one bilateral). Intraoperative findings, operation times, and infection signs were recorded and analyzed. All patients met systemic infection criteria, with a mean body temperature of 38.7°C ± 1.7°C. Leukocytosis was noted in 8 (57.1%) patients. Elevated C-reactive protein (8.5 ± 6.3 mg/L) and procalcitonin (24.1 ± 22.0 ng/mL) were found in 13 (92.9%) and 9 (64.3%) patients, respectively. Mean stone size was 8.5 ± 6.3 mm, mostly localized to the upper ureter (upper: 12; middle: 0; lower: 3). Mean operation time was 14.1 ± 4.3 min. After emergency drainage, all patients improved and were discharged after infection was controlled. The average length of admission was 6.2 ± 2.2 days. Conclusion RUS under local anesthesia is safe and effective for treating infective hydronephrosis due to ureteral stone obstruction. A randomized controlled trial with a large sample remains necessary to validate these findings.
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Affiliation(s)
- Chun-Kai Hsu
- Division of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Wan-Ling Young
- Division of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Shu-Yu Wu
- Division of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
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Abdrabuh AM, El-Agamy ESI, Elhelaly MA, Abouelgreed TA, Abdel-Al I, Youssof HA, Elatreisy A, Shalkamy O, Elebiary M, Agha M, Tagreda I, Alrefaey A, Elawadey E. Value of preoperative ureteral wall thickness in prediction of impaction of ureteric stones stratified by size in laser ureteroscopic lithotripsy. BMC Urol 2023; 23:3. [PMID: 36609272 PMCID: PMC9825030 DOI: 10.1186/s12894-022-01168-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/23/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To evaluate the role of preoperative UWT in the prediction of impaction of ureteral stones stratified according to stone size in ureteroscopic laser lithotripsy. PATIENT AND METHODS This study included 154 patients submitted to URSL for ureteral stones. Radiological data comprised the presence of hydronephrosis, anteroposterior pelvic diameter (PAPD), proximal ureteric diameter (PUD), and maximum UWT at the stone site. Collected stone characteristics were stone size, side, number, site, and density. RESULTS The study included 154 patients subjected to URSL. They comprised 74 patients (48.1%) with impacted stones and 80 (51.9%) with non-impacted stones. Patients were stratified into those with stone size ≤ 10 mm and others with stone size > 10 mm. In the former group, we found that stone impaction was significantly associated with higher PAPD, PUD, and UWT. In patients with stone size > 10 mm, stone impaction was related to higher UWT, more stone number, and higher frequency of stones located in the lower ureter. ROC curve analysis revealed good power of UWT in discrimination of stone impaction in all patients [AUC (95% CI) 0.65 (0.55-0.74)] at a cut-off of 3.8 mm, in patients with stone size ≤ 10 mm [AUC (95% CI) 0.76 (0.61-0.91)] at a cut-off of 4.1 mm and in patients with stone size > 10 mm [AUC (95% CI) 0.72 (0.62-0.83)] at a cut-off of 3.0 mm. CONCLUSIONS Stratifying ureteric stones according to size would render UWT a more practical and clinically-oriented approach for the preoperative prediction of stone impaction.
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Affiliation(s)
- Abdrabuh M. Abdrabuh
- grid.411303.40000 0001 2155 6022Urology Department, Al-Azhar University, Cairo, Egypt
| | - El-Sayed I. El-Agamy
- grid.411303.40000 0001 2155 6022Urology Department, Al-Azhar University, Cairo, Egypt ,Present Address: Armed forced Hospital, Alhada, Saudi Arabia
| | - Mohamed A. Elhelaly
- grid.411303.40000 0001 2155 6022Urology Department, Al-Azhar University, Cairo, Egypt ,Present Address: Armed forced Hospital, Alhada, Saudi Arabia
| | - Tamer A. Abouelgreed
- grid.411303.40000 0001 2155 6022Urology Department, Al-Azhar University, Cairo, Egypt
| | - Ibrahim Abdel-Al
- grid.411303.40000 0001 2155 6022Urology Department, Al-Azhar University, Assuit Branch, Assuit, Egypt
| | | | - Adel Elatreisy
- grid.411303.40000 0001 2155 6022Urology Department, Al-Azhar University, Cairo, Egypt
| | - Osama Shalkamy
- grid.411303.40000 0001 2155 6022Urology Department, Al-Azhar University, Cairo, Egypt
| | - Mohamed Elebiary
- grid.411303.40000 0001 2155 6022Urology Department, Al-Azhar University, Cairo, Egypt
| | - Mohammed Agha
- grid.411303.40000 0001 2155 6022Urology Department, Al-Azhar University, Cairo, Egypt
| | - Ibrahim Tagreda
- grid.411303.40000 0001 2155 6022Urology Department, Al-Azhar University, Cairo, Egypt
| | - Ahmed Alrefaey
- grid.411303.40000 0001 2155 6022Urology Department, Al-Azhar University, Cairo, Egypt
| | - Elsayed Elawadey
- grid.411303.40000 0001 2155 6022Urology Department, Al-Azhar University, Cairo, Egypt
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11
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Predictive factors for stone management timing after emergency percutaneous nephrostomy drainage in patients with infection and hydronephrosis secondary to ureteral calculi. Urolithiasis 2022; 51:1. [DOI: 10.1007/s00240-022-01380-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/04/2022] [Indexed: 12/03/2022]
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Law YXT, Shen L, Khor VWS, Chen W, Chen WJK, Durai P, Gauhar V, Lie KY, Lee KCJ. Choosing the best way for urinary decompression and developing a novel predictive model for septic shock using SOFA in these patients. Int J Urol 2022; 29:1488-1496. [PMID: 36070249 DOI: 10.1111/iju.15023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/01/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To identify predictive factors for the development of sepsis/septic shock postdecompression of calculi-related ureteric obstruction using the Sequential Organ Failure Assessment (SOFA) score and to compare clinical outcomes and odd risk ratios of patients developing sepsis/septic shock following the insertion of percutaneous nephrostomy (PCN) versus insertion of retrograde ureteral stenting (RUS). METHODS Clinico-epidemiological data of patients who underwent PCN and/or RUS in two institutions for calculi-related ureteric obstruction were retrospectively collected from January 2014 to December 2020. RESULTS 537 patients (244 patients in PCN group, 293 patients in RUS group) from both institutions were eligible for analysis based on inclusion and exclusion criteria. Patients with PCN were generally older, had poorer Eastern Cooperative Oncology Group status, and larger obstructive ureteral calculi compared to patients with RUS. Patients with PCN had longer durations of fever, the persistence of elevated total white cell and creatinine, and longer hospitalization stays compared with patients who had undergone RUS. RUS up-front has more unsuccessful interventions compared with PCN. There were no significant differences in the change in SOFA score postintervention between the two interventions. In multivariate analysis, the higher temperature just prior to the intervention (adjusted odds ratio [OR]: 2.039, p = 0.003) and Cardiovascular SOFA score of 1 (adjusted OR:4.037, p = 0.012) were significant independent prognostic factors for the development of septic shock postdecompression of ureteral obstruction. CONCLUSIONS Our study reveals that both interventions have similar overall risk of urosepsis, septic shock and mortality rate. Despite a marginally higher risk of failure, RUS should be considered in patients with lower procedural risk. Patients going for PCN should be counseled for a longer stay. Post-HDU/-ICU monitoring, inotrope support postdecompression should be considered for patients with elevated temperature within 1 h preintervention and cardiovascular SOFA score of 1.
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Affiliation(s)
| | - Liang Shen
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Vincent Wei Sheng Khor
- Department of Urology, Ng Teng Fong General Hospital, Singapore.,Department of Urology, Hospital Pengajar Universiti Putra Malaysia, Malaysia
| | - Weiren Chen
- Department of Urology, National University Hospital, Singapore
| | | | - Pradeep Durai
- Department of Urology, Ng Teng Fong General Hospital, Singapore
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore
| | - Kwok Ying Lie
- Department of Urology, Ng Teng Fong General Hospital, Singapore.,Advanced Urology, Gleneagles Hospital, Singapore
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Pietropaolo A, Seoane LM, Abadia AAS, Geraghty R, Kallidonis P, Tailly T, Modi S, Tzelves L, Sarica K, Gozen A, Emiliani E, Sener E, Rai BP, Hameed ZBM, Liatsikos E, Rivas JG, Skolarikos A, Somani BK. Emergency upper urinary tract decompression: double-J stent or nephrostomy? A European YAU/ESUT/EULIS/BSIR survey among urologists and radiologists. World J Urol 2022; 40:1629-1636. [PMID: 35286423 PMCID: PMC8918906 DOI: 10.1007/s00345-022-03979-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 09/01/2021] [Indexed: 10/29/2022] Open
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Yoo JW, Lee KS, Chung BH, Kwon SY, Seo YJ, Lee KS, Koo KC. Optimal duration of preoperative antibiotic treatment prior to ureteroscopic lithotripsy to prevent postoperative systemic inflammatory response syndrome in patients presenting with urolithiasis-induced obstructive acute pyelonephritis. Investig Clin Urol 2021; 62:681-689. [PMID: 34387040 PMCID: PMC8566789 DOI: 10.4111/icu.20210160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/06/2021] [Accepted: 06/14/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE There is no consensus on the optimal duration of preoperative antibiotic treatment prior to ureteroscopic lithotripsy in patients presenting with urolithiasis-induced obstructive acute pyelonephritis (APN). We aimed to identify surgeon-modifiable, preoperative risk factors associated with postoperative systemic inflammatory response syndrome (SIRS) in these patients. MATERIALS AND METHODS This multicenter retrospective study evaluated 115 patients who presented with urolithiasis-induced obstructive APN between January 2008 and December 2019. All patients were administered intravenous third-generation cephalosporin until culture sensitivity confirmation or until ureteroscopic lithotripsy. Data were collected for age, sex, diabetes mellitus, performance status, stone features, hydronephrosis grade, preoperative renal collecting system drainage, laboratory data, operative time, and duration of preoperative antibiotic treatment. Sensitivity analysis using Youden's index and logistic regression analysis were used to assess risk factors of postoperative SIRS. RESULTS Postoperative SIRS was identified in 32 (27.8%) patients. The incidence of postoperative SIRS was higher in patients who received preoperative antibiotic treatment for fewer than 14 days (38.8% vs. 12.5%; p=0.001). Backward variable selection logistic regression analysis revealed maximal stone diameter ≥15 mm, duration of preoperative antibiotic treatment <14 days, and preoperative C-reactive protein (CRP) level ≥6.0 mg/L to be associated with higher risk of postoperative SIRS. CONCLUSIONS Patients with urolithiasis-induced obstructive APN planned for ureteroscopic lithotripsy should be administered at least 14 days of preoperative antibiotic administration and achieve a serum CRP level ≤6.0 mg/L to minimize the risk of postoperative SIRS.
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Affiliation(s)
- Jeong Woo Yoo
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kwang Suk Lee
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Ha Chung
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se Yun Kwon
- Department of Urology, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
| | - Young Jin Seo
- Department of Urology, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
| | - Kyung Seop Lee
- Department of Urology, Keimyung University Gyeongju Dongsan Hospital, Keimyung University School of Medicine, Gyeongju, Korea
| | - Kyo Chul Koo
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Hinojosa-Gonzalez DE, Torres-Martinez M, Villegas-De Leon SU, Galindo-Garza C, Roblesgil-Medrano A, Alanis-Garza C, Gonzalez-Bonilla E, Barrera-Juarez E, Flores-Villalba E. Emergent urinary decompression in acute stone-related urinary obstruction: A systematic review and meta-analysis. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211017027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Emergent urinary decompression through percutaneous nephrostomy (PCN) or ureteric stent (URS) remains a mainstay in the management of urethral calculi-related obstruction with associated signs of infection or renal injury. Available evidence has shown similar performance, and current guidelines endorse both treatment strategies. Methods: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analysis criteria up until August 2020. Studies included data on stone size and location, operative time, complications, length of stay, analgesic consumption, quality of life (QoL), and clinical outcomes between URS and PCN. Results: Ten studies with a total population of 772, of which 420 were treated with URS and 352 with PCN, were included. No statistical difference in operative time between both techniques was found. Nevertheless, length of stay in PCN was longer than in USR, with a mean difference of −1.87 days ((95% CI −2.69 to −1.06), Z=4.50, p=0.00001). No differences were found in the time to normalization of temperature or white blood cell counts. There were no significant differences in success rates, with an overall odds ratio (OR) of 0.60 ((95% CI 0.26 to −1.40), Z=1.17, p=0.24), or spontaneous passage after emergent drainage between groups. Complication rates ranged from 5% to 25% in URS and from 0% to 38% in PCN. In the studied population, out of the 157 patients from four studies describing complications, only 5% of URS procedures presented complications compared to 2% in PCN, showing a relatively low complication rate for either group (OR=2.07 (95% CI 0.89–4.84), Z=1.68, p=0.09). Differences in QoL were not significant. Conclusion: Both methods are equally effective, with no clear advantage for PCN over URS. Level of evidence: IV
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Affiliation(s)
| | | | | | | | | | | | | | | | - Eduardo Flores-Villalba
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Mexico
- Escuela Nacional de Ingeniería, Departamento de Ciencias Clínicas, Tecnológico de Monterrey, Hospital Zambrano Hellion, Col. Real de San Agustin, Mexico
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Zul Khairul Azwadi I, Norhayati MN, Abdullah MS. Percutaneous nephrostomy versus retrograde ureteral stenting for acute upper obstructive uropathy: a systematic review and meta-analysis. Sci Rep 2021; 11:6613. [PMID: 33758312 PMCID: PMC7988020 DOI: 10.1038/s41598-021-86136-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/09/2021] [Indexed: 11/29/2022] Open
Abstract
Acute obstructive uropathy is associated with significant morbidity among patients with any condition that leads to urinary tract obstruction. Immediate urinary diversion is necessary to prevent further damage to the kidneys. In many centres, the two main treatment options include percutaneous nephrostomy (PCN) and retrograde ureteral stenting (RUS). The purpose of this study if to compare the efficacy and safety of PCN and RUS for the treatment of acute obstructive uropathy. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL, EMBASE, the World Health Organisation International Clinical Trials Registry Platform and ClinicalTrials.gov. We also searched the reference lists of included studies to identify any additional trials. We included randomised controlled trials and controlled clinical trials comparing the outcomes of clinical improvement (septic parameters), hospitalisation duration, quality of life, urinary-related symptoms, failure rates, post-procedural pain [measured using a visual analogue scale (VAS)] and analgesics use. We conducted statistical analyses using random effects models and expressed the results as risk ratio (RR) and risk difference (RD) for dichotomous outcomes and mean difference (MD) for continuous outcomes, with 95% confidence intervals (CIs). Seven trials were identified that included 667 patients. Meta-analysis of the data revealed no difference in the two methods in improvement of septic parameters, quality of life, failure rates, post-procedural pain (VAS), or analgesics use. Patients receiving PCN had lower rates of haematuria and dysuria post-operatively and longer hospitalisation duration than those receiving RUS. PCN and RUS are effective for the decompression of an obstructed urinary system, with no significant difference in most outcomes. However, PCN is preferable to RUS because of its reduced impact on the patient's post-operative quality of life due to haematuria and dysuria, although it is associated with slightly longer hospitalisation duration.
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Affiliation(s)
- Ismail Zul Khairul Azwadi
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
- Hospital Universiti Sains Malaysia, Universiti Sains Malaysia Health Campus, Jalan Raja Perempuan Zainab 2, 16150, Kota Bharu, Kelantan, Malaysia
| | - Mohd Noor Norhayati
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
- Hospital Universiti Sains Malaysia, Universiti Sains Malaysia Health Campus, Jalan Raja Perempuan Zainab 2, 16150, Kota Bharu, Kelantan, Malaysia
| | - Mohd Shafie Abdullah
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia.
- Hospital Universiti Sains Malaysia, Universiti Sains Malaysia Health Campus, Jalan Raja Perempuan Zainab 2, 16150, Kota Bharu, Kelantan, Malaysia.
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17
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Xu ZH, Yang YH, Zhou S, Lv JL. Percutaneous nephrostomy versus retrograde ureteral stent for acute upper urinary tract obstruction with urosepsis. J Infect Chemother 2020; 27:323-328. [PMID: 33309627 DOI: 10.1016/j.jiac.2020.11.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/18/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE We aimed to compare the efficacy of percutaneous nephrostomy (PCN) versus retrograde ureteric stent (RUS) for acute upper urinary tract obstruction with urosepsis. MATERIALS AND METHODS We performed a random study, comparing PCN to RUS, for the treatment of patients requiring emergency drainage due to acute upper urinary tract obstruction with urosepsis between January 2019 to March 2020. Data collected included patient characteristics, stone material, microbiological characteristics, and laboratory data. Statistical analysis was performed by the student's t-test or Mann-Whitney U test or chi-squared test and Fisher exact test. RESULTS At first, a total of 75 patients were eligibly assessed for enrollment. Among them, 3 cases were excluded for declining to participate and 7 cases were failed treated with RUS. At last, 35 PCN (53.85%) and 30 RUS (46.15%) patients were analyzed. There were 24 (36.92%) men and 41 (63.08%) women. The median age was 65 years. Emergency decompression was achieved by PCN in 35 (53.85%) patients and by RUS in 30 (46.15%). Urine culture was positive in 32 (49.23%) patients, of which 17 (53.13%) had E. coli. Postoperative C-reactive protein value and normal temperature recovery time in the PCN group were significantly lower than in the RUS group(P < .05). CONCLUSION PCN had a better outcome than RUS in emergency drainage with urosepsis, especially for patients with severe inflammation and fever.
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Affiliation(s)
- Zi-Hao Xu
- Department of Urology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu, 211100, China
| | - Yan-Hao Yang
- Department of Urology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu, 211100, China
| | - Shuang Zhou
- Department of Urology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu, 211100, China
| | - Jian-Lin Lv
- Department of Urology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu, 211100, China.
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18
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Acute Kidney Injury Caused by Obstructive Nephropathy. Int J Nephrol 2020; 2020:8846622. [PMID: 33312728 PMCID: PMC7719507 DOI: 10.1155/2020/8846622] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/21/2020] [Accepted: 11/11/2020] [Indexed: 12/15/2022] Open
Abstract
Acute kidney injury secondary to obstructive nephropathy is a frequent event that accounts for 5 to 10% of all acute kidney injury cases and has a great impact on the morbidity and mortality in those affected. The obstruction in the urinary tract has a profound impact on kidney function due to damage produced by ischemic and inflammatory factors that have been associated with intense fibrosis. This pathology is characterized by its effects on the management of fluids, electrolytes, and the acid-base mechanisms by the renal tubule; consequently, metabolic acidosis, hyperkalemia, uremia, and anuria are seen during acute kidney injury due to obstructive nephropathy, and after drainage, polyuria may occur. Acute urine retention is the typical presentation. The diagnosis consists of a complete medical history and should include changes in urinary voiding and urgency and enuresis, history of urinary tract infections, hematuria, renal lithiasis, prior urinary interventions, and constipation. Imaging studies included tomography or ultrasound in which hydronephrosis can be seen. Management includes, in addition to drainage of the obstructed urinary tract system, providing supportive treatment, correcting all the metabolic abnormalities, and initiating renal replacement therapy when required. Although its recovery is in most cases favorable, it seems to be an undervalued event in nephrology and urology. This is because it is mistakenly believed that the resolution and recovery of kidney function is complete once the urinary tract is unobstructed. It can have serious kidney sequelae. In this review, we report the epidemiology, incidence, pathophysiological mechanisms, diagnosis, and treatment of acute kidney injury due to obstructive nephropathy.
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19
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Haas CR, Smigelski M, Sebesta EM, Mobley D, Shah O. Implementation of a Hospital-Wide Protocol Reduces Time to Decompression and Length of Stay in Patients with Stone-Related Obstructive Pyelonephritis with Sepsis. J Endourol 2020; 35:77-83. [PMID: 32668984 DOI: 10.1089/end.2020.0626] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction and Objectives: Patients with obstructive pyelonephritis (OPN) require urgent decompression through retrograde ureteral stent (RUS) or percutaneous nephrostomy (PCN). In 2016, the urology and interventional radiology (IR) departments at our institution established a protocol for patients with OPN with sepsis. The primary objectives were to assess this protocol's impact on improving time to decompression and whether more expedient decompression decreased length of stay (LOS). Secondarily, we assessed the impact of the protocol and clinical factors on receipt of PCN over RUS. Materials and Methods: One hundred forty-seven patients at our institution who underwent PCN from 2012 to 2017 or stent from 2014 to 2017 for stone-related OPN meeting sepsis criteria were retrospectively reviewed. Univariate descriptive statistics compared patient characteristics and outcomes between RUS and PCN pre- and postprotocol implementation. Multivariable logistic regression assessed predictors of decompression with PCN (vs RUS) and of prolonged LOS (pLOS; >5 days). Results: Utilization of PCN increased after implementation of the protocol from 4 to 14 PCN/year with a decrease in the median time from urologic consultation to PCN from 9.2 to 4.3 hours (p = 0.001) with overall median time to decompression decreasing from 5.4 to 4.5 hours (p = 0.017). Predictors of undergoing PCN (vs RUS) included increasing comorbidity and ≥1 cm obstructing stone. On multivariable analysis controlling for comorbidity, leukocytosis, and septic shock, increasing hours to decompression increased odds of pLOS (1.08, 95% confidence interval 1.02-1.15, p = 0.014). Conclusions: After implementing our OPN with sepsis protocol, time to decompression decreased with dramatic improvement in time to PCN. Quicker decompression was independently associated with reduced odds of prolonged hospital stay. A well-designed protocol engages both urology and IR in the management of these acutely ill patients and improves outcomes.
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Affiliation(s)
- Christopher R Haas
- Department of Urology and Columbia University Irving Medical Center/NewYork Presbyterian Hospital, New York, New York, USA
| | - Michael Smigelski
- Department of Urology and Columbia University Irving Medical Center/NewYork Presbyterian Hospital, New York, New York, USA
| | - Elisabeth M Sebesta
- Department of Urology and Columbia University Irving Medical Center/NewYork Presbyterian Hospital, New York, New York, USA
| | - David Mobley
- Department of Radiology, Columbia University Irving Medical Center/NewYork Presbyterian Hospital, New York, New York, USA
| | - Ojas Shah
- Department of Urology and Columbia University Irving Medical Center/NewYork Presbyterian Hospital, New York, New York, USA
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20
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Scheidt MJ, Hohenwalter EJ, Pinchot JW, Ahmed O, Bjurlin MA, Braun AR, Kim CY, Knavel Koepsel EM, Schramm K, Sella DM, Weiss CR, Lorenz JM. ACR Appropriateness Criteria® Radiologic Management of Urinary Tract Obstruction. J Am Coll Radiol 2020; 17:S281-S292. [PMID: 32370972 DOI: 10.1016/j.jacr.2020.01.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/25/2020] [Indexed: 11/24/2022]
Abstract
Acute obstructive uropathy is a medical emergency, which often is accompanied by acute renal failure or sepsis. Treatment options to resolve the acute obstructive process include conservative medical management, retrograde ureteral stenting, or placement of percutaneous nephrostomy or nephroureteral catheters. It is important to understand the various treatment options in differing clinical scenarios in order to guide appropriate consultation. Prompt attention to the underlying obstructive process is often imperative to avoid further deterioration of the patient's clinical status. A summary of the data and most up-to-date clinical trials regarding treatment options for urinary tract obstruction is outlined in this publication. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Eric J Hohenwalter
- Panel Chair, Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jason W Pinchot
- Panel Vice-Chair, University of Wisconsin, Madison, Wisconsin
| | | | - Marc A Bjurlin
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; American Urological Association
| | - Aaron R Braun
- St. Elizabeth Regional Medical Center, Lincoln, Nebraska
| | - Charles Y Kim
- Duke University Medical Center, Durham, North Carolina
| | | | - Kristofer Schramm
- University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado
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Bakr M, Abdelhalim KM. Safety and Efficacy of Emergency Ureteroscopy with Intracorporeal Lithotripsy in Patients Presented with Urinary Tract Infection with Mild Sepsis. J Endourol 2020; 34:262-266. [PMID: 31989843 DOI: 10.1089/end.2019.0550] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: To assess safety and efficacy of emergency ureteroscopy (URS) with intracorporeal lithotripsy for management of distal ureteral stones in highly selected cases presented with urinary tract infection (UTI) with mild sepsis. Patients and Methods: Patients presenting with a solitary distal ureteral stone ≤20 mm with UTI with mild sepsis at two tertiary care centers between January 2016 and December 2018 were included. Patients were randomly assigned into one of two groups; Group I (GI) managed by direct emergency definitive URS and Group II (GII) managed by Double-J ureteral stent insertion. Both groups were compared regarding operative time, time to normalization of leukocytosis and temperature, analgesic consumption, length of hospital stay, and any perioperative complications. Stone-free status was defined as complete stone removal or residual nonobstruction fragments of ≤2 mm. Results: A total of 124 patients were included; 55 in GI and 69 in GII. Both groups were comparable regarding demographic and baseline data, length of hospital stay (2.0 ± 0.14 vs 1.99 ± 0.12 days, p = 0.78), time to normalization of total leukocytic count and body temperature, and analgesic consumption. Patients in GII had significantly lower operative time, compared to those in GI (22.2 ± 6.7 vs 44.6 ± 8.7 minutes, p < 0.001). Stone-free rate in GI was 98.1%. Both groups were comparable in postoperative adverse events [5 (9.1%) vs 8 (11.6%), p = 0.76], respectively, in GI and GII. Most complications were low grade, without reported mortality rate. Conclusion: Emergency URS with intracorporeal lithotripsy seems to be safe and efficient definitive alternative to temporary ureteral stenting in highly selected patients presenting with UTI with mild sepsis secondary to obstructing distal ureteral stones.
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Affiliation(s)
- Mohamed Bakr
- Urology Department, Port-Said University, Port-Said, Egypt
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22
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Zhang Z, Wang X, Chen D, Peng N, Chen J, Wang Q, Yang M, Zhang Y. Minimally invasive management of acute ureteral obstruction and severe infection caused by upper urinary tract calculi. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2020; 28:125-135. [PMID: 31796723 DOI: 10.3233/xst-190576] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSETo evaluate therapeutic efficacy of two minimally invasive surgical methods in managing acute ureteral obstruction and severe infection caused by upper urinary tract calculi (UUTC).PATIENTS AND METHODSData of 47 patients diagnosed with acute upper urinary tract obstruction and severe infection caused by ureteral calculus using X-ray CT between September 2014 and January 2019 were retrospectively analyzed. All patients were treated with immediate renal drainage and, after infection and ureteral obstruction were relieved, UUTC removal. Renal drainage was performed by ultrasound-guided percutaneous nephrostomy and retrograde ureteral catheterization was performed using cystoscopy. Kidney and ureteral stones were removed; renal function and the urinary tract were examined by X-ray during follow-up.RESULTSPercutaneous nephrostomy was performed in 29 patients in a critical condition including intolerance to surgery, high-grade hydronephrosis, or failure of retrograde ureteric stent placement. In other 18 patients diagnosed with small stones (≤10 mm) and low-grade hydronephrosis, indwelling double-J ureteral stents were temporally installed by a cystoscope. Acute infection and ureteral obstruction were relieved; white blood cell counts returned to normal values within 3 to 7 days after drainage in all patients. In the second-stage treatment, percutaneous nephrolithotomy (PCNL), ureteroscopic lithotripsy, extracorporeal shock wave lithotripsy and nephrectomy were performed in 24, 10, 8 and 5 patients, respectively. No patients developed severe complication after stone removal surgery. All patients were followed up for 3 months to 4.5 years. Renal function was significantly recovered; 17/29 (59%) patients with elevated serum creatinine returned to normal and serum creatinine in 12/29 (41%) patients improved significantly after drainage, with a pre-operation level of 285±169μM vs 203±91μM post-operation (P = 0.014). Five patients were lost during follow-up.CONCLUSIONThis study demonstrated an optimal approach for relieving upper urinary tract obstruction and acute infection in which percutaneous nephrostomy drainage is preferred for patients with severe pyonephrosis, large stones (>10 mm) with high-grade hydronephrosis, steinstrasse, or failure in retrograde ureteric stent placement, while retrograde ureteral catheterization using cystoscopy is suitable for patients diagnosed with small stones (≤10 mm) and low-grade hydronephrosis.
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Affiliation(s)
- Zejian Zhang
- Department of Urology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province, China
| | - Xisheng Wang
- Department of Urology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province, China
| | - Dong Chen
- Department of Urology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province, China
| | - Naixiong Peng
- Department of Urology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province, China
| | - Jicheng Chen
- Department of Urology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province, China
| | - Qinjun Wang
- Department of Urology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province, China
| | - Minlong Yang
- Department of Urology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province, China
| | - Yuanyuan Zhang
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Mao W, Liu S, Wang K, Wang M, Shi H, Liu Q, Bao M, Peng B, Geng J. Cystatin C in Evaluating Renal Function in Ureteral Calculi Hydronephrosis in Adults. Kidney Blood Press Res 2019; 45:109-121. [PMID: 31801142 DOI: 10.1159/000504441] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/29/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Serum cystatin C (CysC) is still becoming used as a marker of renal function but is far from being commonly used worldwide. The purpose of this study was to characterize the ureteral calculi patients with hydronephrosis-caused CysC changes in renal function. METHODS To better reflect the changes of renal function, we constructed models of ureteral obstruction in rats to mimic the hydronephrosis caused by human ureteral calculi. Moreover, our study included 200 patients diagnosed with ureteral calculi in our hospital between June 2017 and 2018. We compared the estimated glomerular filtration rate using different equations based on CysC and/or serum creatinine (SCr). RESULTS We found that the expression of CysC and SCr increased with the prolonged obstruction time by enzyme linked immunosorbent assay. Moreover, quantitative real-time polymerase chain reaction, Western blot and immunohistochemistry further demonstrated that the expression of CysC increases with the degree of hydronephrosis. Among 200 patients with ureteral calculi, 40 (20.0%) had no hydronephrosis, 110 (55.0%) had mild hydronephrosis, 32 (16.0%) had moderate hydronephrosis and 18 (9.0%) had severe hydronephrosis. As the degree of hydronephrosis increased, the expression of neutrophil percentage, CysC, blood urea nitrogen, SCr and serum uric acid also increased. Multivariate analyses demonstrated that only CysC was an independent risk factor for hydronephrosis (p = 0.003). In addition, CysC and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) CysC equation showed the highest veracity in renal function estimation of patients with hydronephrosis caused by ureteral calculus. CONCLUSION For patients with hydronephrosis caused by ureteral calculi, CysC better reflects the changes in renal function, and the CKD-EPI CysC equation has the highest accuracy.
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Affiliation(s)
- Weipu Mao
- Department of Urology, People's Hospital of Putuo District, Shanghai, China.,Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Shenghua Liu
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Keyi Wang
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Miao Wang
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Heng Shi
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Qunlong Liu
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Meiyu Bao
- Department of Central Laboratory, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Bo Peng
- Department of Urology, People's Hospital of Putuo District, Shanghai, China.,Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Jiang Geng
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China,
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Analysis of the clinical effect and long-term follow-up results of retroperitoneal laparoscopic ureterolithotomy in the treatment of complicated upper ureteral calculi (report of 206 cases followed for 10 years). Int Urol Nephrol 2019; 51:1955-1960. [DOI: 10.1007/s11255-019-02252-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 07/30/2019] [Indexed: 01/16/2023]
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25
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Early Stone Manipulation in Urinary Tract Infection Associated with Obstructing Nephrolithiasis. Case Rep Urol 2019; 2018:2303492. [PMID: 30595937 PMCID: PMC6286750 DOI: 10.1155/2018/2303492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/06/2018] [Indexed: 11/18/2022] Open
Abstract
A urinary tract infection (UTI) and sepsis secondary to an obstructing stone are one of the few true urological emergencies. The accepted management of infected ureteral stones includes emergent decompression of the collecting system as well as antibiotic therapy. Despite this, no consensus guidelines clarify the optimal time to undergo definitive stone management following decompression. Historically, our institution has performed ureteroscopy with laser lithotripsy (URS-LL) treatment at least 1 to 2 weeks after decompression to allow for clinical improvement and completion of an antibiotic course. In this case series, we retrospectively review four cases in which patients had a documented UTI secondary to an obstructive ureteral stone. The patients underwent urgent decompression and, based on labs and clinical improvement, were subsequently treated with URS-LL. The presented patients received URS-LL within 5 days of decompression and antibiotics. The patients had no sepsis related postoperative complications from the accelerated course of treatment, resulting in discharge within 2 days following URS-LL. We provide a detailed examination of each patient presentation to describe our institution's experience with treating infected kidney stones within days of urgent decompression in order to question the previous standard of treating an infected kidney stone with a more delayed intervention.
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The impact of ureteral stent indwelling time on the treatment of acute infection caused by ureteral calculi. Urolithiasis 2017; 45:579-583. [PMID: 28229196 DOI: 10.1007/s00240-017-0964-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/30/2017] [Indexed: 10/20/2022]
Abstract
Ureteric stenting is an effective drainage method in patients with acute urinary tract infection caused by ureteral calculi; however, the optimal ureteral stent indwelling time has not been clearly defined. The aim of this study was to evaluate the effect of ureteric stent indwelling time on the treatment of acute infection secondary to urinary tract calculi. A total of 142 patients with acute infection caused by urinary tract calculi were identified retrospectively from January 2011 to August 2015 at our institution. 63 patients were with ureteric stenting for 7 days (A group) and 79 patients with ureteric stenting for more than 7 days (B group). The patient characteristics of two groups were analyzed and the clinical data before and after stenting were compared. The postoperative complication outcomes were collected and analyzed. Effective drainage obtained from ureteral stenting clearly abated the infection after stenting for 7 days; WBC count, WBCs in urine, and positive rate of urine culture were significantly decreased compared with the condition of immediate stenting. Both groups showed similar stone clearance rates (96.8% vs. 96.2%, p = 0.841), and there was no significant difference in the rate of postoperative complications, especially related to urinary tract infection (6.3% vs. 6.3%, p = 1.000). It is safe and effective for patients with acute urinary tract infection secondary to urinary tract calculi to be treated by ureteroscopic lithotripsy after stenting for one week. Prolonging the stenting period achieves no added benefit for patients.
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27
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How to manage sepsis associated with ureteral calculi? Urolithiasis 2016; 44:285-6. [PMID: 26898641 DOI: 10.1007/s00240-016-0865-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 02/09/2016] [Indexed: 10/22/2022]
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